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Response- and Biology-Based Therapy for Intermediate-Risk Neuroblastoma


Phase 3
N/A
12 Years
Open (Enrolling)
Both
Neuroblastoma

Thank you

Trial Information

Response- and Biology-Based Therapy for Intermediate-Risk Neuroblastoma


OBJECTIVES:

Primary

- Reduce therapy for patients with intermediate-risk neuroblastoma while maintaining a
3-year overall survival (OS) rate of ≥ 95% by using a response-based duration of
therapy algorithm.

- Maintain an overall 3-year OS rate of ≥ 90% for patients within each group.

- Utilize loss of heterozygosity, prospectively, at 1p36 and 11q23 to refine
risk-stratification and treatment assignment, allowing patients whose tumors lack these
chromosomal abnormalities to receive a reduction in therapy, and compare the outcome
with patients treated on COG-A3961.

- Reduce intensity of therapy for patients 365 to < 547 days (12-18 months) of age with
stage 4 neuroblastoma and favorable biological features and maintain a 3-year
event-free survival (EFS) rate consistent with that for patients < 1 year of age with
stage 4 neuroblastoma treated on COG-A3961.

- Reduce intensity of therapy for patients 365 to < 547 days (12-18 months) of age with
stage 3 MYCN-nonamplified but unfavorable histology neuroblastoma and maintain a 3-year
EFS rate consistent with that for patients < 1 year of age with stage 3,
MYCN-nonamplified, unfavorable histology neuroblastoma treated on COG-A3961.

- Reduce surgical morbidity for patients with stage 4S neuroblastoma by allowing for
biopsy only, rather than complete surgical resection, of the primary tumor.

- Systematically study the outcome of patients with stage 4S neuroblastoma who are unable
to undergo biopsy for biology-based risk assignment.

- Determine if the extent of surgical resection correlates with the maintenance of local
control, EFS and/or OS rates, and surgical complication rate.

Secondary

- Determine the results of a standard retrieval approach for patients with residual
disease after 8 courses of initial therapy.

- Determine the results of a standard retrieval approach for patients with progressive,
nonmetastatic disease.

- Identify additional biological surrogate markers for disease relapse and/or metastatic
progression.

- Describe the neurologic outcome of patients with paraspinal neuroblastoma primary
tumors.

- Correlate surgical biopsy technique with adequacy of tissue acquisition for biologic
studies and with complications associated with the biopsy procedure.

- Prospectively validate the prognostic ability of the International Neuroblastoma Risk
Group image-defined risk factor system, and compare the institutional assessment of
image-defined risk factors with that of central review.

OUTLINE: This is a multicenter study. Patients are assigned to 1 of 4 treatment groups by
risk-stratification based on age, stage (INSS stage 2, 3, 4, or 4S), MYCN status (amplified
vs not amplified), histopathologic classification, and tumor DNA index.

- Initial chemotherapy: Courses of initial chemotherapy are administered every 21 days
according to group assignment as outlined below:

- Course 1: Patients receive carboplatin IV over 1 hour on day 1 and etoposide IV
over 1 hour on days 1-3.

- Course 2: Patients receive carboplatin IV over 1 hour, cyclophosphamide IV over 1
hour, and doxorubicin hydrochloride IV over 15 minutes on day 1.

- Course 3: Patients receive cyclophosphamide IV over 1 hour on day 1 and etoposide
IV over 1 hour on days 1-3.

- Course 4: Patients receive carboplatin IV over 1 hour and doxorubicin
hydrochloride IV over 15 minutes on day 1 and etoposide IV over 1 hour on days
1-3.

- Course 5: Patients receive cyclophosphamide IV over 1 hour on day 1 and etoposide
IV over 1 hour on days 1-3.

- Course 6: Patients receive carboplatin IV over 1 hour, cyclophosphamide IV over 1
hour, and doxorubicin hydrochloride IV over 15 minutes on day 1.

- Course 7: Patients receive carboplatin IV over 1 hour on day 1 and etoposide IV
over 1 hour on days 1-3.

- Course 8: Patients receive cyclophosphamide IV over 1 hour and doxorubicin
hydrochloride IV over 15 minutes on day 1.

- Group 1: Patients receive 2 courses of initial chemotherapy. Patients with a
partial response (PR) (50-90% reduction in volume) to chemotherapy proceed to
observation. Patients without a PR receive 2-6 additional courses of
chemotherapy (beginning with course 3). Patients who do not achieve a PR
after additional chemotherapy proceed to retrieval chemotherapy.

- Group 2: Patients receive 4 courses of initial chemotherapy. Patients with a
PR after chemotherapy proceed to observation. Patients without a PR receive
2-4 additional courses of chemotherapy (beginning with course 5). Patients
who do not achieve a PR after additional chemotherapy proceed to retrieval
chemotherapy.

- Group 3: Patients receive 8 courses of initial chemotherapy. Patients under
12 months of age with stage 3, 4, or 4S (not including liver metastases)
disease who achieve a very good PR (VGPR) (> 90% reduction in the volume of
the primary tumor and resolution of metastatic disease) to chemotherapy
proceed to observation. Patients 12-18 months of age with stage 3 or 4
disease who achieve a VGPR proceed to isotretinoin therapy. Patients who do
not achieve a VGPR proceed to retrieval chemotherapy.

- Group 4: Patients receive 8 courses of initial chemotherapy. If a VGPR cannot
be achieved following 8 courses of first-line chemotherapy +/- surgery, then
retrieval chemotherapy with cyclophosphamide/topotecan for 2-6 courses is
administered until a VGPR can be achieved with a combination of chemotherapy
and surgery.

- Retrieval chemotherapy*: Patients receive cyclophosphamide IV over 30 minutes and
topotecan IV over 30 minutes on days 1-5. Treatment repeats every 21 days for up to 6
courses.

- Groups 1 and 2: Patients with a PR after 2-6 courses of retrieval chemotherapy
proceed to observation. Patients without a PR after 2-6 courses of retrieval
chemotherapy are removed from protocol therapy.

- Group 3: Patients under 12 months of age with stage 4 disease with a VGPR after
retrieval chemotherapy proceed to observation. Patients 12-18 months of age with
stage 3 or 4 disease who achieve a VGPR after retrieval chemotherapy proceed to
isotretinoin therapy. Patients who do not achieve a VGPR after retrieval
chemotherapy are removed from protocol therapy.

- Group 4: Group 4 patients who fail to achieve a VGPR or who develop progressive,
non-metastatic disease within 3 years of study enrollment proceed to isotretinoin
therapy. Isotretinoin is also administered to the following Group 4 patients:

- Age 365 to < 547 days at diagnosis, INSS stage 3, MYCN-NA, unfavorable
histology, any ploidy

- Age 365 to < 547 days at diagnosis, INSS stage 4, MYCN-NA, favorable
histology, DI > 1 NOTE: *Patients who have previously received
cyclophosphamide and topotecan to achieve first PR/VGPR are not eligible for
this Retrieval Therapy.

- Surgery: With the exception of patients with INSS 4S disease, patients undergo surgery
to remove as much of the primary tumor and involved lymph nodes as can safely be
accomplished. Reassessment for definitive surgery (for patients who undergo biopsy only
or partial resection at diagnosis) is made at the completion of scheduled chemotherapy
(after course 2 for group 1, after course 4 for group 2, and after course 8 for groups
3 and 4).

- Isotretinoin therapy: Beginning 3-4 weeks after completion of chemotherapy or 2 weeks
post-operatively (for patients who undergo surgical resection), patients receive oral
isotretinoin twice daily on days 1-14. Treatment repeats every 28 days for 6 courses in
the absence of disease progression or unacceptable toxicity.

After completion of study therapy, patients are followed up periodically for up to 10 years.

Data from patients with low-risk disease who are observed following surgical resection only
and are not enrolled on ANBL0531, are collected for study objectives.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed neuroblastoma, ganglioneuroblastoma, or
ganglioneuroma/maturing subtype

- Newly diagnosed disease

- Intermediate-risk disease

- Needle biopsies or involved bone marrow are not sufficient for INPC histologic
classification

- Meets 1 of the following criteria:

- Group 1

- International Neuroblastoma Staging System (INSS) stage 2A/2B; < 50%
resected or biopsy only; ≤ 12 years of age; MYCN-not amplified (NA); any
histology and ploidy; normal 1p and 11q

- INSS stage 3; age < 365 days; MYCN-NA; favorable histology (FH);
hyperdiploid (DI) > 1; normal 1p and 11q

- INSS stage 3; 365 days to 12 years of age; MYCN-NA; FH; normal 1p and 11q

- INSS stage 4S; age < 365 days; MYCN-NA; FH; DI >1; normal 1p and 11q;
clinically symptomatic

- Group 2

- INSS stage 2A/2B; < 50% resected or biopsy only; ≤ 12 years of age;
MYCN-NA; any histology and ploidy; 1p loss of heterozygosity (LOH) and/or
unb11q LOH (or data missing for either)

- INSS stage 3; age < 365 days; MYCN-NA; FH; DI > 1; 1p LOH and/or unb11q LOH
(or data missing for either)

- INSS stage 3; age < 365 days; MYCN-NA; DI = 1 and/or unfavorable histology
(UH); normal 1p and 11q

- INSS stage 3; 365 days to 12 years of age; MYCN-NA; FH; 1p LOH and/or
unb11q LOH (or data missing for either)

- INSS stage 4; age < 365 days; MYCN-NA; FH; DI > 1; normal 1p and 11q

- INSS stage 4S; age < 365 days; MYCN-NA; either UH and any ploidy or FH and
DI = 1; normal 1p and 11q

- INSS stage 4S; age < 365 days; MYCN-NA; FH; DI > 1; 1p LOH and/or unb11q
LOH (or data missing for either); clinically symptomatic

- Group 3

- INSS stage 3; age < 365 days; MYCN-NA; DI = 1 and/or UH; 1p LOH and/or
unb11q LOH (or data missing for either)

- INSS stage 3; age 365 to < 547 days; MYCN-NA; UH; any ploidy; any 1p and
11q

- INSS stage 4, age < 365 days; MYCN-NA; DI = 1 and/or UH; any 1p and 11q

- INSS stage 4; age < 365 days; MYCN-NA; FH; DI > 1; 1p LOH and/or unb11q LOH
(or data missing for either)

- INSS stage 4; age 365 to < 547 days; MYCN-NA; FH; DI > 1; any 1p and 11q

- INSS stage 4S; age < 365 days; MYCN-NA; UH and any ploidy or FH and DI = 1;
1p LOH and/or unb11q LOH (or data missing for either)

- INSS stage 4S; age < 365 days; unknown or incomplete biologic features

- Group 4

- INSS stage 3, age < 365 days, MYCN-NA, either DI = 1 and/or UH, 1p LOH
and/or unb11q LOH (or data missing for either)

- INSS stage 3, age 365 to < 547 days, MYCN-NA, UH, any ploidy, any 1p and
11q 3

- INSS stage 4, age < 365 days, MYCN-NA either DI = 1 and/or UH, any 1p and
11q

- INSS stage 4, age < 365 days, MYCN-NA, FH, DI > 1, 1p LOH and/or unb11q LOH
(or data missing for either)

- INSS stage 4, age 365 to < 547 days, MYCN-NA, FH, DI > 1, any 1p and 11q

- INSS stage 4S, age < 365 days, MYCN-NA, either UH and any ploidy or FH and
DI = 1 and 1p LOH and/or unb11q LOH (or data missing for either)

- INSS stage 4S, age < 365 days, unknown MYCN, histology, and/or ploidy

- Must already be enrolled on protocol COG-ANBL00B1

- Simultaneous enrollment on COG-ANBL00B1 and this study allowed for clinical
situations in which emergent treatment may be indicated including, but not
limited to, the following criteria:

- Epidural or intraspinal tumors with existing or impending neurologic
impairment

- Periorbital or calvarial-based lesions with existing or impending cranial
nerve impairment

- Anatomic or mechanical compromise of critical organ function by tumor
(e.g., abdominal compartment syndrome, urinary obstruction)

- Asymptomatic but, in the opinion of the treating physician, it is in the
patient's best interest to begin chemotherapy immediately due to impending
risk of neurologic impairment or organ dysfunction

- If patient receives study chemotherapy prior to undergoing diagnostic biopsy, the
biopsy must be performed within 96 hours of beginning study therapy

- The only exception to this requirement is for patients with stage 4S disease who
are considered too ill to undergo a diagnostic procedure will be waived the
requirement for diagnostic tissue submission but will still need to be enrolled
on COG-ANBL00B1

- For patients with stage 4S disease who are very ill and in whom an open
biopsy to obtain tissue for diagnosis and biologic studies is considered
medically contraindicated, every effort should be made to obtain some tumor
tissue by either fine-needle aspiration of a metastatic site of disease
and/or sampling of involved bone marrow, so that this tumor sample can be
submitted for MYCN determination

- Patients who require emergent therapy, either prior to the diagnostic biopsy or
before biology features are available, can be enrolled simultaneously on COG-ANBL00B1
and COG-ANBL0531 to receive emergent protocol therapy

- In emergent circumstances, COG-ANBL0531 protocol therapy may be initiated prior
to enrollment on study as long as the patient has neuroblastoma by clinical
diagnosis, all other COG-ANBL0531 eligibility criteria are met, and the
COG-ANBL0531 Initial Therapy consent has been signed prior to starting protocol
therapy; in this circumstance ANBL0531 enrollment must occur within 4 working
days of starting protocol therapy

- Clinical situations in which emergent enrollment and treatment may be indicated
include, but are not limited to, the following circumstances:

- Epidural or intraspinal tumors with existing or impending neurologic
impairment

- Periorbital or calvarial-based lesions with existing or impending cranial
nerve impairment

- Anatomic or mechanical compromise of critical organ function by tumor
(e.g., abdominal compartment syndrome, urinary obstruction)

- Evolving hepatomegaly in infants less than 2 months of age

PATIENT CHARACTERISTICS:

- See Disease Characteristics

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- No other prior chemotherapy or radiotherapy with the exception of dexamethasone

- No participation in another COG study with tumor therapeutic intent

Type of Study:

Interventional

Study Design:

Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Overall survival (OS) rates

Outcome Description:

A log-rank test comparison of the overall cohort to the analogous cohort on P9641/A3961 will be used. If these are not statistically significantly different, then it is reasonable to assume that a 3-year OS rate consistent with previous studies (> 95%) has been maintained.

Outcome Time Frame:

From the date of enrollment until death, or until last contact if the patients is alive, assessed up to 3 years

Safety Issue:

No

Principal Investigator

Clare Twist, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Lucile Packard Children's Hospital at Stanford University Medical Center

Authority:

United States: Federal Government

Study ID:

ANBL0531

NCT ID:

NCT00499616

Start Date:

October 2007

Completion Date:

Related Keywords:

  • Neuroblastoma
  • regional neuroblastoma
  • disseminated neuroblastoma
  • stage 4S neuroblastoma
  • localized unresectable neuroblastoma
  • localized resectable neuroblastoma
  • Neuroblastoma

Name

Location

Roswell Park Cancer InstituteBuffalo, New York  14263
Children's Hospital of PhiladelphiaPhiladelphia, Pennsylvania  19104
Mayo Clinic Cancer CenterRochester, Minnesota  55905
Cardinal Bernardin Cancer Center at Loyola University Medical CenterMaywood, Illinois  60153-5500
Walter Reed Army Medical CenterWashington, District of Columbia  20307-5000
University of Chicago Cancer Research CenterChicago, Illinois  60637
Barbara Ann Karmanos Cancer InstituteDetroit, Michigan  48201
Duke Comprehensive Cancer CenterDurham, North Carolina  27710
Tripler Army Medical CenterHonolulu, Hawaii  96859-5000
Hurley Medical CenterFlint, Michigan  48503
Medical City Dallas HospitalDallas, Texas  75230
University of Texas Health Science Center at San AntonioSan Antonio, Texas  78284-7811
CCOP - KalamazooKalamazoo, Michigan  49007-3731
Presbyterian - St. Luke's Medical CenterDenver, Colorado  80218
Van Elslander Cancer Center at St. John Hospital and Medical CenterGrosse Pointe Woods, Michigan  48236
Sanford Cancer Center at Sanford USD Medical CenterSioux Falls, South Dakota  57117-5039
Vanderbilt-Ingram Cancer CenterNashville, Tennessee  37232-6838
University of Wisconsin Paul P. Carbone Comprehensive Cancer CenterMadison, Wisconsin  53792-6164
Marshfield Clinic - Marshfield CenterMarshfield, Wisconsin  54449
Newark Beth Israel Medical CenterNewark, New Jersey  07112
New York Medical CollegeValhalla, New York  10595
Holden Comprehensive Cancer Center at University of IowaIowa City, Iowa  52242-1002
Ellis Fischel Cancer Center at University of Missouri - ColumbiaColumbia, Missouri  65203
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical CenterLebanon, New Hampshire  03756-0002
Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel HillChapel Hill, North Carolina  27599-7570
CCOP - Scott and White HospitalTemple, Texas  76508
Sidney Kimmel Comprehensive Cancer Center at Johns HopkinsBaltimore, Maryland  21231-2410
Cancer Research Center of HawaiiHonolulu, Hawaii  96813
Cleveland Clinic Taussig Cancer CenterCleveland, Ohio  44195
Sutter Cancer CenterSacramento, California  95816
Children's Hospital of Orange CountyOrange, California  92668
Children's National Medical CenterWashington, District of Columbia  20010-2970
Children's Mercy HospitalKansas City, Missouri  64108
St. Joseph's Hospital and Medical CenterPaterson, New Jersey  07503
Children's Hospital and Regional Medical Center - SeattleSeattle, Washington  98105
University of California Davis Cancer CenterSacramento, California  95817
Nemours Children's ClinicJacksonville, Florida  32207
All Children's HospitalSt. Petersburg, Florida  33701
Children's Memorial Hospital - ChicagoChicago, Illinois  60614
Saint Jude Midwest AffiliatePeoria, Illinois  61637
Cardinal Glennon Children's HospitalSaint Louis, Missouri  63104
Schneider Children's HospitalNew Hyde Park, New York  11042
St. Christopher's Hospital for ChildrenPhiladelphia, Pennsylvania  19134-1095
St. Jude Children's Research HospitalMemphis, Tennessee  38105-2794
Driscoll Children's HospitalCorpus Christi, Texas  78466
Cook Children's Medical Center - Fort WorthFort Worth, Texas  76104
Inova Fairfax HospitalFalls Church, Virginia  22042-3300
City of Hope Comprehensive Cancer CenterDuarte, California  91010
Fletcher Allen Health Care - University Health Center CampusBurlington, Vermont  05401
Phoenix Children's HospitalPhoenix, Arizona  85016-7710
Southern California Permanente Medical GroupDowney, California  90242
Children's Hospital Central CaliforniaMadera, California  93638-8762
Kosair Children's HospitalLouisville, Kentucky  40202-3830
Palmetto Health South Carolina Cancer CenterColumbia, South Carolina  29203
East Tennessee Children's HospitalKnoxville, Tennessee  37901
Covenant Children's HospitalLubbock, Texas  79410
Children's Hospital of the King's DaughtersNorfolk, Virginia  23507
Midwest Children's Cancer Center at Children's Hospital of WisconsinMilwaukee, Wisconsin  53226
Arizona Cancer Center at University of Arizona Health Sciences CenterTucson, Arizona  85724
Arkansas Cancer Research Center at University of Arkansas for Medical SciencesLittle Rock, Arkansas  72205
Blumenthal Cancer Center at Carolinas Medical CenterCharlotte, North Carolina  28232-2861
Overlook HospitalSummit, New Jersey  07902-0220
Winthrop University HospitalMineola, New York  11501
Loma Linda University Cancer Institute at Loma Linda University Medical CenterLoma Linda, California  92354
Jonathan Jaques Children's Cancer Center at Miller Children's HospitalLong Beach, California  90801
Kaiser Permanente Medical Center - OaklandSacramento, California  95825
Yale Cancer CenterNew Haven, Connecticut  06520-8028
Lee Cancer Care of Lee Memorial Health SystemFort Myers, Florida  33901
Broward General Medical Center Cancer CenterFt. Lauderdale, Florida  33316
University of Florida Shands Cancer CenterGainesville, Florida  32610-0232
Baptist-South Miami Regional Cancer ProgramMiami, Florida  33176
Nemours Children's Clinic - OrlandoOrlando, Florida  32806
Florida Hospital Cancer Institute at Florida Hospital OrlandoOrlando, Florida  32803-1273
St. Joseph's Cancer Institute at St. Joseph's HospitalTampa, Florida  33607
Kaplan Cancer Center at St. Mary's Medical CenterWest Palm Beach, Florida  33407
Blank Children's HospitalDes Moines, Iowa  50309
Alvin and Lois Lapidus Cancer Institute at Sinai HospitalBaltimore, Maryland  21215
Floating Hospital for Children at Tufts - New England Medical CenterBoston, Massachusetts  02111
Breslin Cancer Center at Ingham Regional Medical CenterLansing, Michigan  48910
Hackensack University Medical Center Cancer CenterHackensack, New Jersey  07601
Albert Einstein Cancer Center at Albert Einstein College of MedicineBronx, New York  10461
NYU Cancer Institute at New York University Medical CenterNew York, New York  10016
SUNY Upstate Medical University HospitalSyracuse, New York  13210
Mission Hospitals - Memorial CampusAsheville, North Carolina  28801
Presbyterian Cancer Center at Presbyterian HospitalCharlotte, North Carolina  28233-3549
Wake Forest University Comprehensive Cancer CenterWinston-Salem, North Carolina  27157-1096
Cincinnati Children's Hospital Medical CenterCincinnati, Ohio  45229-3039
Rainbow Babies and Children's HospitalCleveland, Ohio  44106-5000
Toledo HospitalToledo, Ohio  43606
Rhode Island Hospital Comprehensive Cancer CenterProvidence, Rhode Island  02903
Hollings Cancer Center at Medical University of South CarolinaCharleston, South Carolina  29425
Texas Tech University Health Sciences Center School of Medicine - AmarilloAmarillo, Texas  79106
Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - DallasDallas, Texas  75390
Baylor University Medical Center - HoustonHouston, Texas  77030-2399
Methodist Children's Hospital of South TexasSan Antonio, Texas  78229-3993
Primary Children's Medical CenterSalt Lake City, Utah  84113-1100
Naval Medical Center - PortsmouthPortsmouth, Virginia  23708-2197
Providence Cancer Center at Sacred Heart Medical CenterSpokane, Washington  99220-2555
St. Vincent Hospital Regional Cancer CenterGreen Bay, Wisconsin  54307-3508
Saint Peter's University HospitalNew Brunswick, New Jersey  08901-1780
James P. Wilmot Cancer Center at University of Rochester Medical CenterRochester, New York  14642
Greenebaum Cancer Center at University of Maryland Medical CenterBaltimore, Maryland  21201
UNMC Eppley Cancer Center at the University of Nebraska Medical CenterOmaha, Nebraska  68198-7680
Memorial Cancer Institute at Memorial Regional HospitalHollywood, Florida  33021
University of South Alabama Mitchell Cancer InstituteMobile, Alabama  36604
Childrens Hospital Los AngelesLos Angeles, California  90027
Children's Hospital and Research Center OaklandOakland, California  94609
Lucile Packard Children's Hospital at Stanford University Medical CenterPalo Alto, California  95798
Rady Children's Hospital - San DiegoSan Diego, California  92123-4282
UCSF Helen Diller Family Comprehensive Cancer CenterSan Francisco, California  94115
Children's Hospital Center for Cancer and Blood DisordersAurora, Colorado  80045
Alfred I. duPont Hospital for ChildrenWilmington, Delaware  19803
Lombardi Comprehensive Cancer Center at Georgetown University Medical CenterWashington, District of Columbia  20007
M.D. Anderson Cancer Center at OrlandoOrlando, Florida  32806
AFLAC Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta - Egleston CampusAtlanta, Georgia  30322
MBCCOP - Medical College of Georgia Cancer CenterAugusta, Georgia  30912-3730
Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical CenterSavannah, Georgia  31403-3089
Mountain States Tumor Institute at St. Luke's Regional Medical CenterBoise, Idaho  83712-6297
University of Illinois Cancer CenterChicago, Illinois  60612-7243
Keyser Family Cancer Center at Advocate Hope Children's HospitalOak Lawn, Illinois  60453
Advocate Lutheran General Cancer Care CenterPark Ridge, Illinois  60068-1174
Simmons Cooper Cancer InstituteSpringfield, Illinois  62794-9677
Indiana University Melvin and Bren Simon Cancer CenterIndianapolis, Indiana  46202-5289
Lucille P. Markey Cancer Center at University of KentuckyLexington, Kentucky  40536-0093
Tulane Cancer Center Office of Clinical ResearchAlexandria, Louisiana  71315-3198
CancerCare of Maine at Eastern Maine Medical CenterBangor, Maine  04401
Maine Children's Cancer Program at Barbara Bush Children's HospitalScarborough, Maine  04074-9308
Dana-Farber/Harvard Cancer Center at Dana-Farber Cancer InstituteBoston, Massachusetts  02115
C.S. Mott Children's Hospital at University of Michigan Medical CenterAnn Arbor, Michigan  48109-0286
Masonic Cancer Center at University of MinnesotaMinneapolis, Minnesota  55455
Children's Hospitals and Clinics of Minnesota - MinneapolisMinneapolis, Minnesota  55404
University of Mississippi Cancer ClinicJackson, Mississippi  39216-4505
Siteman Cancer Center at Barnes-Jewish Hospital - Saint LouisSt. Louis, Missouri  63110
Children's HospitalOmaha, Nebraska  68114-4113
CCOP - Nevada Cancer Research FoundationLas Vegas, Nevada  89109-2306
Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical SchoolNew Brunswick, New Jersey  08903
University of New Mexico Cancer CenterAlbuquerque, New Mexico  87131-5636
Albany Medical Center HospitalAlbany, New York  12208-3419
Maimonides Cancer Center at Maimonides Medical CenterBrooklyn, New York  11219
Herbert Irving Comprehensive Cancer Center at Columbia University Medical CenterNew York, New York  10032
Akron Children's HospitalAkron, Ohio  44308-1062
Nationwide Children's HospitalColumbus, Ohio  43205-2696
Dayton Children's - DaytonDayton, Ohio  45404-1815
Oklahoma University Cancer InstituteOklahoma City, Oklahoma  73104
Knight Cancer Institute at Oregon Health and Science UniversityPortland, Oregon  97239-3098
Legacy Emanuel Hospital and Health Center and Children's HospitalPortland, Oregon  97227
Geisinger Cancer Institute at Geisinger HealthDanville, Pennsylvania  17822-0001
Penn State Children's HospitalHershey, Pennsylvania  17033-0850
Children's Hospital of Pittsburgh of UPMCPittsburgh, Pennsylvania  15213
Dell Children's Medical Center of Central TexasAustin, Texas  78723
Virginia Commonwealth University Massey Cancer CenterRichmond, Virginia  23298-0037
Carilion Medical Center for Children at Roanoke Community HospitalRoanoke, Virginia  24014
Madigan Army Medical Center - TacomaTacoma, Washington  98431
Mary Bridge Children's Hospital and Health Center - TacomaTacoma, Washington  98405
West Virginia University Health Sciences Center - CharlestonCharleston, West Virginia  25302
University of Virginia Cancer CenterCharlottesville, Virginia  22908
Massachusetts General HospitalBoston, Massachusetts  02114-2617
UAB Comprehensive Cancer CenterBirmingham, Alabama  35294
University of Miami Sylvester Comprehensive Cancer Center - MiamiMiami, Florida  33136
Lehigh Valley Hospital - MuhlenbergBethlehem, Pennsylvania  18017
Greenville Hospital Cancer CenterGreenville, South Carolina  29605
T.C. Thompson Children's HospitalChattanooga, Tennessee  37403
Connecticut Children's Medical CenterHartford, Connecticut  06106
Nemours Children's Clinic - PensacolaPensacola, Florida  32504
Helen DeVos Children's Hospital at Spectrum HealthGrand Rapids, Michigan  49503
Mercy Children's HospitalToledo, Ohio  43608